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Protecting Our Youth: Understanding the Effects of Multiple Concussions

Julia Noppenberger

Independent Research G/T

Dr. Kiehl
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Abstract:

In America, the number of concussions in youth sports is rapidly growing with millions of

people having concussions every year and the number of concussion-related emergency room

visits increasing drastically (Brainline, 2018). This rapid growth causes this subject to be

extremely relevant to today’s society as more and more people face the detrimental effects. The

purpose of this research was to identify the long-term effects of repeated concussions and what

prevention and treatment methods would be best to reduce the recovery time and the risk for

long-term effects. It was hypothesized that numerous concussions cause an increased risk for

degenerative disease, mental illness, and cognitive impairments; increased awareness of

concussion severity and the use of advancing technology can greatly improve prevention and

treatment. Through an online survey and a literature review, it was found that multiple

concussions do cause an increased risk for degenerative disease, especially CTE, but are less

likely to cause mental illness and cognitive deficits. Also, effective prevention methods could be

educating players, coaches, and parents, teaching proper techniques, and the advancement of

helmet technology. Treatment suggestions include the use of baseline concussion testing,

individualized methods, and an overall understanding between doctors, coaches, and players

throughout the entire recovery process.


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Introduction​:

There is a growing problem of concussions in youth sports, as the number of concussions each

year continues to rise and scientists gain a better understanding of how concussions truly affect

the brain. I am specifically researching the problem and correlation between repeated

concussions on the development of degenerative diseases and cognitive deficits. I plan to help

solve this problem by evaluating the prevention and treatment methods for concussions in

hopes of reducing the effects that concussions can have on the lives of individuals. I plan to

conduct this research and help solve this problem through correlational and descriptive

research, using a survey for data collection, and creating either a video or website as a product

in order to teach the general public about the dangers of concussions and how they can be

avoided and treated.

Review of Literature:

Concussions are one of the most common injury in America with around 1.6-3.8 million

occurring every year (Brain Injury Research Institute, n.d.). There is a growing problem of

concussions in youth sports, as the number continues to rise each year and scientists gain a

better understanding of how concussions truly affect the brain. Long term effects of concussions

include cognitive deficits, mental illnesses, and degenerative diseases, including Chronic

Traumatic Encephalopathy.​ Methods for reducing the number of concussions and decreasing

their negative long term effects would be implementing new technology and protocols, enforcing

the rules of the game in a safer and more proper manner, and educating the athletes, parents,

and coaches. ​This paper will work to define concussions and identify their most common

symptoms, explain why concussions are an important problem and how the issue is growing,

establish the correlation between repetitive head trauma and the development of degenerative
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diseases and cognitive deficits, and determine the most/more effective prevention and treatment

methods for concussions.

Concussions are a serious problem in youth sports as their effects are becoming more

known and the number of concussions are rising, consequently causing a larger impact on

modern athletes in all sports. A concussion is a mild traumatic brain injury (mTBI) caused by a

sudden and/or hard hit to the head, which then causes the brain to spin and/or move inside the

head. This causes damage to the brain cells and structures (Office of Public Affairs, 2016).

Concussions can also occur when the body suddenly decelerates or stops, usually in a car

accident, because the brain hits against the skull. Concussions are graded on a three-point

scale, which can be used to make treatment decisions. A grade one concussion is mild and is

defined by no loss of consciousness, and symptoms that resolve within 15 minutes, whereas a

grade 2, moderate concussion also has no loss of consciousness, however symptoms take

longer than 15 minutes to resolve. The most severe grade of concussion is a grade 3, classified

as “intense,” which is when there is a loss of consciousness of any length(“Concussion,” 2006).

Common symptoms of a concussion include headaches, confusion, dizziness, nausea and

vomiting, fatigue, blurred vision, and sensitivity to light and noise(Office of Public Affairs, 2016).

Symptoms can last for a varied length of time, but severe, longer-lasting symptoms possibly

indicate a more severe brain injury. When a person gets a concussion, they may or may not

lose consciousness, and if this state of unconsciousness is longer than several minutes, this

also indicates a more severe brain injury. If a person is still experiencing symptoms days or

weeks after the incident, it is possible they are experiencing post-concussion syndrome.

Symptoms may include headaches, anxiety, depression, sleep disturbances, memory

difficulties, and others (“Concussion,” 2006). It is vital that the proper prevention and treatment
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methods be created to ensure that these symptoms and consequences stop occurring to so

many people.

Concussions must also be understood in a more specific and scientific way in order to

apprehend exactly why certain prevention or treatment methods are better than others. A

concussion is a brain injury that causes a temporary loss of normal brain function and may

affect memory, judgement, reflexes, speech, balance and muscle coordination. The medical

definition is “a clinical syndrome characterized by immediate and transient alteration in brain

function, including alteration of mental status and level of consciousness, resulting from

mechanical force or trauma,” (American Association of Neurological Surgeons, n.d.). Symptoms

that physicians usually look for in order to diagnose a concussion are the inability to maintain a

coherent stream of thought, a disturbance of awareness with raised distractibility, and the

inability to carry out a sequence of goal-directed movements, since this type of brain injury may

not be observable in routine neurological exams. The brain is cushioned inside the skull, which

protects the brain against penetrating trauma, by the surrounding cerebrospinal fluid. However,

the skull does not absorb all the impact of a force and an abrupt blow to the head or a rapid

deceleration can cause the brain to make contact with the skull. This has the potential to tear

blood vessels, pull nerve fibers, bruise brain substance, and occasionally result in microscopic

damage to the brain cells that would not be obviously visible on a CT scan (American

Association of Neurological Surgeons, n.d.). When a person sustains a concussion, the damage

can be explained on a macroscopic, microscopic, and molecular view. Macroscopic damage is

tissue changes or cerebral blood flow changes as a result of direct trauma. On a microscopic

view, membranes of the cells stretch and lose their ability to regulate the cell’s environment,

thus preventing the brain cells from working properly. This leads to effects in behavior,

concentration, memory, and other cognitive areas. Molecularly, the injury causes a changes in
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neurons, which prevents the brain from working normally (XLNT Brain Sport, n.d.). The scientific

definition and explanation of concussions further reiterates why it is vital to develop more

effective prevention methods to ensure that this type of neurological damage can occur to a

fewer number of people. This biological definition will also help to explain why certain prevention

and treatment methods will work better than others by looking at it at a cellular level.

The number of concussions in youth is rising at an alarming rate, with the number of

emergency department visits related to concussions and traumatic brain injuries rising 57% in

children from 2001-2009. More than 3.8 million concussions occurring every year in the US from

competitive sports and recreational activities alone, and this statistic is with 50% of concussions

going unreported, usually for either minimal knowledge in the area or the athlete’s unwillingness

to admit injury. Approximately 2.5 million students reported having one concussion in a year,

and around 1 million reported having two more more concussions (Brainline, 2018). This is an

incredibly large amount of students affected in only one year from an injury that can be better

prevented if the proper methods are implemented, such as education, use of new technology

and proper techniques, and enforcing the rules. However, these statistics may be lower than in

actuality because many coaches, players, and parents do not know how to recognize the

symptoms of a concussion and athletes may pretend they are okay to stay in the game (The

Micheli Center for Sports Injury and Prevention, n.d.). This further emphasizes the need for an

improved program for concussion education for coaches, players, and parents to make sure

they are not only able to understand the symptoms of a concussion in order to help diagnose

and initially seek treatment, but to make the player more aware that a concussion is a serious

matter that needs to be acknowledged and treated immediately. Besides injury, another way to

guarantee that the athlete does not remain dishonest about their injury in order to return to their

daily life or keep playing the sport is to establish a relationship between the athlete and the
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doctor. In these interactions , the doctor must help the athlete understand that they are only

trying to get the athlete back to normal activities as fast as possible, and everything they do is in

their best interest (Gioia, 2019). Concussions are a growing problem that need to be addressed

and understood because many children are suffering its effects without the most effective

treatment and prevention methods to prevent more serious long-term effects.

In athletics, concussions are usually caused due to the same general reasons, but there

are some things that can make it so one person has a greater risk for a concussion than

another. Gender and age are two demographics that have potential effects on the probability of

getting a concussion. Females seem to have a different risk and recovery than males; this is

most likely because males and females have different brains, hormones, level of neck strength

and stability. Additionally, in a large Canadian Study participated in by Dr. Gioia called the Five

Piece Study, 3000 kids from the age of 5-18 were studied and it was found that adolescence

had the longest length of recovery. This study showed that adolescents took longer to recover

out of all of those studied, and adolescent females took the longest to recover. Additionally,

having a history of migraines, sleeping problems, anxiety, or mood difficulties could also add to

ones recovery. Also, children with attention deficit disorder (ADD) and/or learning disabilities

also tend to be at a higher risk for concussions to begin with, so one’s background medical and

developmental history plays a role in a child’s recovery from a concussion and some children

are more at risk than others to sustain this injury (Gioia, 2019). One of the most prominent risk

factors for a concussion is history of concussions because after an athlete’s first concussion,

they are four times more likely to suffer another. One concussion should not cause permanent

damage, but the the problems start to arise when the injuries start to compound each other

because a second soon after the first does not have to be very strong for its effects to be

permanently damaging (Powell, 1996). Concussions are already dangerous, but they become
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even more dangerous as the number of concussions one sustains increases. Methods for

prevention need to be specialized for people with certain risk factors and need to be bettered to

guarantee that people are not suffering multiple concussions in one lifetime, because this is

when the grave dangers begin.

Another goal of this paper is to establish the correlation between repetitive head trauma

and the development or risk for degenerative diseases and cognitive deficits. One of the most

profound degenerative diseases believed to be caused by repetitive brain injury is Chronic

Traumatic Encephalopathy (CTE). CTE is a progressive, degenerative disease found in people

with a history of repetitive brain trauma and can only be diagnosed after death in an autopsy.

Athletes who began playing contact sports at younger ages and athletes with longer careers

playing contact sports are at a greater risk for the development of CTE. Symptoms of CTE

include changes in a patient’s mood or behavior, including impulse control problems,

aggression, depression, and paranoia. As the disease continues to progress, some may

experiences problems with thinking and memory, which may eventually become progressive

dementia. Cognitive symptoms, like thinking and memory, usually appear later than mood and

behavioral symptoms (Concussion Legacy Foundation, n.d.). Other symptoms of CTE may

include a progressive decline of memory and executive functioning, and mood and behavioral

disturbances such as depression, apathy, impulsivity, anger, irritability, suicidal behavior, and

aggressiveness. On a gross, or anatomical examination, CTE can be characterized by

“generalized atrophy and enlarged ventricles, specific atrophy of the frontal and medial temporal

lobes,” (Hallenbeck & Bissinger, 2012). In a brain with CTE, a protein called Tau forms clumps

that slowly spread throughout the brain, which then kills brain cells (Concussion Legacy

Foundation, n.d.). CTE causes cerebral atrophy, which is shrinking of the brain, and in

autopsies it was found that approximately a 30% shrinkage of the frontal, parietal, and temporal
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lobes of affected brains (Seeker, 2016). CTE is a taupathic disease, which means that there is

no cure and after symptoms develop and the disease sets in, the damage is irreversible. The

only way to treat CTE is by managing the symptoms. Mood changes like depression, irritability

and anxiety, can be treated with cognitive behavioral therapy. Headaches can be treated in a

multitude of different ways, and there are memory training exercises to help cope with memory

problems.

However, recent evidence has shown that subconcussive impacts, and not concussions,

are the driving force behind CTE. Subconcussive impacts are those below the concussion

threshold; the brain is shaken, but not violently enough to observe symptoms. Examples may

include most tackles in football, headers in soccer, body checks in lacrosse, and other extreme

physical aspects of sports. This would mean that some athletes can be diagnosed with CTE

without ever being diagnosed with a concussion because they were hit several times

underneath the concussion threshold. But, these impacts can ultimately add up and cause

serious damage to the brain (Concussion Legacy Foundation, n.d.). Proper prevention and

treatment techniques need to be implemented to ensure that less people have to experience the

dreadful effects of CTE and other degenerative diseases linked to repetitive brain trauma.

Repetitive brain trauma can also lead to cognitive deficits, with effects in memory,

attention, concentration, learning, thinking, and more. In a study performed in 2005 titled

“Prolonged effects of concussion in high school athletes” by Moser, Schatz, and Jordan, it was

tested to see if prolonged neuropsychological effects of concussions in high school athletes,

were present, such as negatively impacting attention and concentration. When measuring

attention and concentration, athletes with recent concussions performed significantly worse that

athletes with no concussion history. Athletes with a history of two or more concussions but were

not currently experiencing symptoms performed similarly to recently concussion athletes in the
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testing from this study. Additionally, cumulative grade point averages were lower for athletes

with two or more previous concussions and athletes who experiences recent concussions. This

study supported that there are neuropsychological and cognitive effects in youth athletes with a

history of multiple concussions, because their testing in attention and concentration was just as

bad as athletes who were currently experiencing a concussion (Moser, Schatz, & Jordan, 2005).

Also, subconcussive hits damage memory and attention. Many studies have shown that athletes

who have had more subconcussive impacts do worse on memory and attention than athletes

who suffer less hits (Concussion Legacy Foundation, n.d.). Although the correlation between

cognitive deficits and repetitive concussions may be present, it can be argued that they are not

very common. The vast majority of concussions result in temporary effects on cognitive function

(Gioia, 2019). Long term effects of concussions are rare and the majority of people do not suffer

from post-concussion syndrome. However, the more concussions someone has, the more likely

they are to suffer the long term consequences (Office of Public Affairs, 2016). The risk for

permanent problems and cognitive damage is especially heightened when multiple injuries

occur and compound each other because the brain is not given enough time to heal (Gioia,

2019). It is important that the proper prevention techniques are established in order to prevent

people from having multiple concussions in their careers and therefore increase their risk of

developing cognitive deficits that would not be present if they were only concussed 1 or 2 times.

In addition to the risk for degenerative disease and cognitive deficits after multiple

concussions, there is also an increased risk for mental illness and psychiatric symptoms,

including depression, anxiety, coping issues, psychosocial disability, and contemplated suicide

(Daneshvar et al., 2011). In a study from 2016 titled “Risk of suicide after a concussion,” experts

assessed the long-term risk of suicide after concussions by performing a longitudinal analysis of

adults with a concussion diagnosis. The study found that adults with a previous diagnosis of a
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concussion had an increased risk of suicide later in life. When the patient did not have any prior

suicide attempts, their risk was more than twice the population norm (Fralick, Thiruchelvam,

Tien, & Redelmeier, 2016). In a case study conducted by the Mayo Clinic, a concussed patient

who lied about her symptoms and returned to normal activities too soon was researched. She

eventually suffered from severe memory loss and chronic headaches. The constant pain led to

her to be extremely sleep deprived, moody, and irritable. Because of these symptoms and her

chronic pain, the girl eventually contemplated suicide (Mayo Clinic, 2016). Patients may also

become frustrated due to participation restrictions for their normal activities, as well as fear for

their future fate, both academically and athletically (Children’s Hospital Colorado, 2013).

Additionally, similar to other long-term injuries, when players are not allowed to play for more

than a week or two, they tend to feel disconnected from their team, oftentimes envious of those

healthy, which leads to endless frustration. When players return from injury, they may have to

regain their assertiveness and aggressiveness on the field because of fear of reinjury. In

addition to this, there might be somewhat an issue of confidence when the player returns to the

field after an injury and they are overly conscious and overcompensating to prevent future injury

(Croft, 2019). It is extremely important that better prevention techniques be created to reduce

the number of concussions a person will sustain in their career which will consequently

decrease the number of long term effects - degenerative diseases, cognitive deficits, and mental

effects.

The most effective prevention methods supported by recent research and studies are

concussion education of parents, coaches, and players, teaching the proper techniques and

enforcing the rules, and the advancement of new technologies. Coaches especially need to

understand concussions so that they know how to properly respond and prepare. Coaches

should be trained to recognize the warning signs of head injuries, be capable of removing
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players from the field promptly, and know how long to keep the players off of the field to heal.

Coaches need to have the proper training and follow the correct precautions during trainings

and games to ensure the athletes’ ultimate safety (Hallenbeck & Bissinger, 2012). Coaches

should plan practice to reduce the risk of injury and make sure that there is access to safe,

proper equipment. Before a training, coaches should try to move obstacles, like other goals or

sand bags, off of the field to reduce tripping hazards and the chance of an athlete falling and

banging their head on the ground (Croft, 2019). Sports fields, playgrounds, and equipment

should have regular safety checks and damaged sporting equipment and protective gear should

be discarded and replaced. This will reduce the risk of injury (American Association of

Neurological Surgeons, n.d.).

Athletes should also be taught the severity and importance of a concussion. 69% of

athletes with a possible concussion played with concussion symptoms and 40% of said athletes

said their coach was unaware they had a possible concussion (Brainline, 2018). Many athletes

do not know that concussions are a serious problem and by continuing playing they are

exposing themselves to risking second impact syndrome and worse effects. Coaches and

parents should talk about the importance of reporting concussions and emphasize that it will not

make them lose their position on the team, look weak, let the team down, and no one will think

poorly of you to take the needed time to heal (CDC, 2016). When educating the family, the

health care professional should include warning signs of a more serious injury, description of the

injury and expected symptoms and recovery, instructions on how to monitor postconcussive

symptoms, prevention of further injury, management of cognitive activity and physical

activity/rest, and clinician follow-up instructions. In general, health literacy and resulting

behavioral modifications optimize health outcomes (Yeates, Gioia, Sarmiento, & Turner, 2018).

The NCAA has implemented a new plan that requires student-athletes to receive information
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about the signs and symptoms of concussions. The student-athletes are also required to sign a

waiver that says they are responsible for reporting injuries to the medical staff. The

implementation of protocols requiring the education of athletes will be extremely beneficial for

improving concussion prevention. Education coaches, parents, and athletes about the

importance and severity of concussions and understanding how to maximize the chances of

reducing the risk for injury during trainings and games is a vital aspect to bettering prevention

methods for concussions.

Additionally, coaches should teach their athletes proper form and techniques for contact

and other risky maneuvers. Teaching where to make contact and where not to make contact,

teaching players to tackle with their shoulders instead of their heads in football, and teaching

how to properly head the ball in soccer by keeping your body and shoulders underneath your

head instead of sticking your head out. Improperly implementing any of these movements can

be extremely dangerous and causes the player to become more susceptible to injury, especially

concussions. Coaches should help the players learn how to properly execute somewhat

dangerous techniques before they develop potentially unsafe habits (Croft, 2019). However,

teaching certain techniques, like heading in soccer, too soon is inappropriate and unnecessary.

In addition to teaching the proper techniques at the right age, the rules of the game need to be

properly enforced by officials and rules of sportsmanship should be required by coaches. When

the game gets out of control from overly aggressive coaches, parents, or athletes, and the

officials do not perform their jobs well, athletes might play in an inappropriate manner, which

increases the risk for injury (Gioia, 2019). Players need to understand that they should avoid

unsafe actions such as striking another athlete in the head, using their head or helmet to contact

another athlete, illegal contacts or tackling, and purposely trying to injure other athletes. There

should be an understanding that good sportsmanship is expected at all times (CDC, 2016). One
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example of how a game could be better officiated and referees could gain a better

understanding is in soccer. In Maryland, there is a state law about concussion and return to play

that states that when a player is hit in the head during a game, the play must stop and they must

be immediately removed from the game. There are referees that do not know this law and are

exposing players to injury and not protecting players. Giving the average offical more

information would greatly improve player safety and the outcomes for players who suffer from

concussions. Officiating the game correctly and teaching the proper techniques is extremely

important for protecting players and reducing the risk for injury.

The third line of defense for protecting against concussions is the use of helmets that fit

properly and provide the maximum protection against head injury (American Association of

Neurological Surgeons, n.d.). However, helmets are not designed to prevent concussions.

Helmets are built to keep the skull from fracturing and to keep the brain from not bleeding.

Helmets were originally created in the early part of the 19th century when football first began

because there were many skull fractures and bleeds in the brain. Athletes were playing

american football without any kind of head protection, so many athletes were dying because

they were fracturing their skulls and they were having bad bleeds in the brain. President of the

time, Teddy Roosevelt, stated that he was going to abolish the game if nothing was done, which

led to the creation of the helmet industry. Recently, companies and research facilities have been

looking to see if they can do something to reduce the risk of concussion. However, it has been

found that increasing the amount of padding in helmets will not better prevent concussions. The

brain moves independently in the skull and sways back and forth regardless of whether there is

a piece of plastic with padding over top of it. The brain will move around regardless of the

amount of padding placed on the outside of the head (Gioia, 2019). In the past couple of years,

research has been conducted where sensors are put in players’ helmets to measure the number
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of impacts they took to the head and the location and magnitude of the impacts. In a study

talked about in a Ted Talk titled “Seeing Through the Fog,” they used these sensors and gave

the players tests on brain function that were repeated throughout the season. Players with

concussions performed worse on the tests, but there were some players with no evident

symptoms who performed just as badly on the tests as their concussed teammates (Tedx Talks,

2013). This study supports the idea that subconcussive impacts pose a greater risk for

concussions than the larger impacts previously thought. This technology used in this study

could be used to create specifically fitted helmets for specific positions that are unique to head

structure and the way their brains react to linear and angular force.

Researchers are trying to build a helmet that measures the force of a hit, and measures

the impact said hit has on a player’s brain. This helmet would include sensors in order to

measure the forces on the player’s brain and not just the forces on the helmet. Helmets with

sensors embedded in the interior lining can be used to detect forces exerted upon the wearer.

The helmet can then send a signal to the sideline when the player should be checked for injury.

This developing helmet technology would greatly improve concussion prevention and possibly

recognize a concussion before the symptoms and condition worsens.

The standard, stereotypical treatment for concussions is rest, but recent research has

suggested that exercise performed below symptom exacerbation for people with prolonged

symptoms may be helpful in reducing postconcussive symptoms and improve the recovery of

the patient. Previously, patients were told only to rest, which included staying isolated from

society for extended periods of time Now, medical professionals are starting to get children

active much earlier than they ever have before and recommending that patients don't do things

that make them feel much worse, but not to be under activated either. Patients can begin to

attend school for portions of the day, participate in light physical activity (walks), or engage in
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social activity so they are not isolated. All of these things are based on the multimodal,

multi-method assessment approach, baseline concussion testing that will be discussed in the

next paragraph (Gioia, 2019). The Center for Disease Control and Prevention (CDC)

recommends that the patient should restrict their physical and cognitive activity during the first

couple of days after injury, but then they can begin to resume a gradual schedule of activity that

does not worsen symptoms. Next, “health care professionals should offer an active rehabilitation

program of progressive reintroduction of non contact aerobic activity that does not exacerbate

symptoms,” and then the patient can return to full activity if they have remained symptom free

throughout the increasing levels of physical exertion. Rest is beneficial to recovery immediately

after the injury, however active rehabilitation models demonstrate that physical exercise below

symptom exacerbation may reduce postconcussive symptoms. The research around rest and its

timing, duration, and efficacy, although it is limited, suggests that early rest (within the first three

days of injury) is likely beneficial, but rest beyond this point may worsen the patient’s symptoms

(Yeates, Gioia, Sarmiento, & Turner, 2018). It is important to have a balance between rest and

return to normal activities when treating a concussion, and this balance is determined by the

patient’s symptoms and whether or not they worsen with certain activities or not.

One impactful piece of technology that will vastly improve the quality of treatment and

recovery for concussed patients is baseline concussion testing. The CDC recommends that

“healthcare professionals may use validated cognitive testing (including measures of reaction

time) to assess recovery in children with mTBI… [and] balance testing to assess recovery,”

(Yeates, Gioia, Sarmiento, & Turner, 2018). Baseline concussion testing is a preseason exam

conducted by trained healthcare professionals which is used to assess an athlete’s balance,

prior history of concussion (including symptoms experienced and their length), presence of

concussion symptoms, and brain functions (memory skills and learning, ability to pay attention
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or concentrate, and how quickly athlete thinks or solves problems), and other medical problems.

The results from this test can then be used and compared to a similar exam taken during the

season after the athlete is suspected of having a concussion. The comparison between the

baseline test results and post-injury results can assist health care professions identify the

effects of the injury and make more informed return to school and sports decisions (CDC, 2016).

The use of baseline concussion testing as a treatment strategy gives doctors more information

on the functional effects of the injury so that they can target the treatment better. Doctors need

to know whether the patient has cognitive, balance, and vision problems, and the baseline

concussion testing will help the doctors determine this information. It will cover various bases to

understand what is affected and what’s not affect, so this will allow doctors to be much more

knowledgeable in treating patients, therefore creating better, more individualized treatment

plans for each patient (Gioia, 2019). This is a simple test that takes around 15 minutes, but this

simple technology can greatly improve the quality of treatment and recovery for concussions

because it allows the healthcare professionals to know more information about their patients.

Concussions require short-term changes in the patient’s daily activity, but as they begin

to feel better and symptoms begin to resolve, the changes are slowly removed. One must use

the symptoms as a guide to return to normal activities, like school and sports. If the symptoms

do not worsen when doing an activity, it is okay to proceed, but if the symptoms worsen, the

patient should cut back on how much they do that activity. Some factors that may delay

recovery are a history of previous concussions or other brain injury, neurological or mental

health disorders, learning difficulties, and family and social stressors. This individual factors

along with the patient’s specific symptoms and circumstances make each patient’s recovery

unique, so it should be customized based on these conditions (CDC, 2016). When developing a

treatment plan, the healthcare professional should assess the individual's symptom profile and
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pattern and they should know what they’re normal life schedule involves. Creating an

individualized and unique treatment plan ensures that the individual recovers as quickly and

appropriately as possible. In addition, in order to optimize recovery, there needs to be an

understanding between the school and the student and medical provider. The school has to be

on board with understanding this injury because the student has to gradually return to school.

The return to school needs to be tailored to the needs of the student. For example, some

students may need a certain number of breaks throughout the day, limited amounts of

homework or tests, additional hallway/transition time between classes, etc.. The school has to

understand why these accommodations are necessary, but many teachers, guidance

counselors, principles, and school nurses are not fully aware of these things and may not be

able to support the student in the proper way (Gioia, 2019). When returning to sports, there

needs to be an understanding between the coach, the player, and the player with constant

communication between all three parties in order to let the athlete heal properly. The coach’s

immediate involvement would be reporting symptoms to the parents and fully informing them

and keeping the player out of play until they’ve had a chance to get checked out by a trainer or

medical doctor. After the initial response, the number one thing a coach can do is respect the

recovery time and understand that the athlete’s health comes first, even if it impacts the team.

When the player comes back, the coach should receive something from the athlete’s doctor

explaining what happened, if there is anything he/she should be aware of, and getting

confirmation that the player is cleared to play. There should also be a communication with the

parents of what soft signs of repeated injury would be, or things that the coach should be aware

of. If the coach then sees these soft sings, they should immediately pull the athlete out of the

play and check in one them. The coach should then communicate with the parents and make

sure that the player is ready to return, or if they should be phased back more gradually (Croft,
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2019). Two essential pieces to improving the treatment and recovery for concussions is creating

unique, specialized treatment plans for every patient and developing an understanding between

the schools and coaches to ensure that both are able to provide the proper accommodations in

order to provide the most beneficial treatment and return to daily activities for the patient.

Concussions are an extremely important problem in our society today and it is vital that

we determine better prevention and treatment methods in order to diminish the severe long-term

effects caused by repeated concussions in youth. The proposed prevention and treatment

methods are what I have determined to be the most promising for decreasing the amount of

concussions and therefore their effects. Now that you understand the severity of concussions

and their grand impact on the brain and body, I hope you will take your injury and recovery

seriously and take the proper amount of time to let your body heal. Missing a couple games or a

couple weeks of sports or activities is better than missing months or years and experiencing

lifelong impacts. Implementing new technology and protocols, enforcing the rules of the game in

a safe and proper manner, and educating athletes, parents, and coaches are the most effective

method for reducing the number of concussions and their negative long-term effects.

Research Methods and Data Collection:

The research question of the research is what are the negative long-term effects of

repeated concussions in youth sports and what are the most effective preventative and

treatment methods? It was hypothesized that repeated concussion cause an increased risk for

CTE, mental illnesses, and degenerative diseases affecting the brain, as well as negatively

impacting attention and concentration, and other cognitive deficits. Increased awareness of

concussions and teaching coaches, parents, and athletes about symptom recognition,

prevention, and treatment could significantly improve concussion recovery.


19

This was correlational research, finding the relationship between number of concussions

and long-term effects as well as prevention and treatment techniques and their relationship to

number of concussions and recovery length and quality. Survey questions were developed that

would highlight the most common long-term effects of multiple concussions and the likelihood of

long-term effects based on the number of concussions, as well as which treatment and

prevention methods led to shorter recoveries and a fewer number of concussions. The survey

was created through google forms and was sent out online through social media. There were

105 participants, both male and female, with a majority of them being student-athletes. The

survey asked the number of concussions the respondent has had, their length of absence from

academics and athletics, whether they had taken a baseline concussion test, if their medical

provider communicated the severity of concussions, and more. The survey can be seen in

Appendix B.

Results and Data Analysis:

Figure 1, Graph: Repetition of Baseline Testing vs Length of Absence from Exercise and School
20

Figure 2, Graph: Whether Athletes were Properly Taught Dangerous Techniques vs Number of
Concussions

Figure 3, Graph: How Often Wear Protective Equipment vs Number of Concussions


21

The data collected through the survey analyzes the relationship between number of

concussions and the risk of long-term effects as well as the prevention and treatment methods

used and number of concussions and recovery length and quality. The results demonstrate that

communicating the severity of concussions to the patient can help decrease the risk of repeated

concussions because the percentage of multiple concussions decreased by 20% when patients

communicate with their doctor about the importance of a concussion. Figure 1 demonstrates

how the data shows that baseline concussion testing can be helpful in shortening recovery time,

regarding school and athletic absence, but it does not have a significant impact. The data, as

seen is Figure 2, also demonstrates that an extremely beneficial prevention technique is

properly teaching dangeorus techniques to the athletes during practice. Coaches teaching

proper techniques can help decrease the number of concussions players have and their initial

risk for having their first concussion. Another extremely beneficial prevention method is the

requirement of wearing protective equipment during practices and compeitions. There is a


22

significant increase in the number of concussions as the required time for wearing protective

equipment decreases. The data demonstrates the effectiveness of prevention and treatment

techniques by comparing the use of the different technique and the length of absence from

school and sports as well as the number of concussions. Additional graphs can be seen in

Appendix A.

Discussion/Conclusion:

Concussions are an extremely important problem in our society today and it is vital that we

determine better prevention and treatment methods in order to diminish the severe long-term

effects caused by repeated concussions in youth. The proposed prevention and treatment

methods are what I have determined to be the most promising for decreasing the number of

concussions and therefore their effects. Missing a couple of games or weeks of sports or

activities is better than missing months or years and experiencing lifelong impacts, like mental

illness, degenerative diseases, and cognitive impairments. Implementing new technology and

protocols, enforcing the rules of the game in a safe and proper manner, and educating athletes,

parents, and coaches are the most effective methods for reducing the number of concussions

and their negative long-term effects. Additionally, the use of baseline concussion treatment and

communicating the severity of concussions with parents and athletes can vastly improve the

recovery of concussed patients. However, the sample size was extremely small and limited, so

the results may not be able to be generalizable to a larger population. In order to increase the

validity of the research, there would need to be more interviews with experts in the field.

References
23

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g_Children

Appendix A

Figure 4a, Graph: Which physical symptoms are still experienced?

Figure 4b, Graph: Which cognitive symptoms are still experienced?


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Appendix B
Concussions

This survey will ask you about your concussion symptoms, history, and recovery (if applicable)
as well as ask about the prevention strategies you are engaged in. Please be as honest and
accurate as possible in your responses. If you have not had a concussion, you can skip this
section after the fourth question (how many concussions have you had?)

* Required

1. ​Do you play any sports? ​*

2. ​If yes, what sport(s)?

3. ​Have you ever had a concussion? ​*


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4. ​How many concussion have you had? ​*

5. ​When was your concussion? (if applicable)

In the past year, 1-2 years ago, 3-4 years ago, 5-6 years ago, 7+ years ago
6. ​How did you get your concussion? (if
applicable)
7. ​What were your symptoms? (if applicable) Please check all that apply

loss of consciousness, headaches, confusion, dizziness, nausea, vomiting, fatigue, blurred


vision, sensitivity to light, sensitivity to noise, anxiety, depression, sleep disturbances, memory
and thinking difficulties, concentration problems, mood and behavioral problems

8. ​If you've had multiple concussions, did you notice your symptoms lasted longer as the
number of concussions increased?

9. ​Approximately how long did your symptoms last?

1 day, a couple of days, 1-2 weeks, 2 weeks to a month, a couple of months, more than a
couple of months
10. ​How long were you not allowed to exercise / play sports?

1 day, a couple of days, 1-2 weeks, 2 weeks to a month, a couple of months, more than a
couple of months

11. ​How long were you out of school?

1 day, a couple of days, 1-2 weeks, 2 weeks to a month, a couple of months, more than a
couple of months

Concussion Prevention ​These questions apply to everyone, even if you haven't had a
concussion. Please be as detailed as possible.

12. ​Have you ever performed a baseline concussion test before participation in sports?
This is
a computerized test that assesses an athlete's balance, presence of any concussion
symptoms, concussion risk factors, and brain functions (learning, memory, attention,
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concentration, and how quickly he/she thinks and solves problems) ​* ​Mark only one oval.
13. ​Did you repeat a baseline concussion test after being suspected of having a
concussion? (If applicable)
14. ​Do you do anything now to prevent (another) concussion? ​*
15. ​If yes to the previous question, please describe.
16. ​During sports practices, does your coach make you wear all protective equipment?
(For
example, shin guards, helmets, padding, etc) ​* ​Mark only one oval.

All the time, most of the time, sometimes, rarely, neverr, not applicable to me (I do not play
sports)

17. ​Were you properly taught the (dangerous) techniques of your sport? (For example,
how to
head the ball in soccer, how to tackle with your shoulders in football, etc) ​*

18. ​If yes to the previous question, please elaborate

Long-term Effects ​This section will evaluate the effects your concussion still has on your life
today. If you have not had a concussion, you can skip this section.

19. ​Do you still experience any symptoms?


20. ​If yes to the previous question, which ones? Please check all that apply

Headaches, confusion, dizziness, nausea, vomiting, , fatigue, blurred vision, sensitive to light,
sensitivity to noise, sleep disturbances

21. ​Do you still feel as though any of the following cognitive functions are affected?
Please
check all that apply ​Check all that apply.

Memory, thinking, attention, concentration, learning, school performance, mental illness


(depression, anxiety, suicidal behavior), mood and behavioral problems (anger, irritability,
aggressiveness)

22. ​How were you treated for your concussion?


23. ​Describe your transition back into normal activities? Did your school, coaches,
parents,
and/or doctors make it easier or more difficult?
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24. ​During your recovery, did anyone communicate with you the severity of concussions
and
try to educate you and your parents about concussions? ​Mark only one oval.

25. ​If yes to the previous question, please elaborate.